V. Ben Sivarajan Derek Best Christian P. Brizard Lara S. Shekerdemian Yves d’Udekem Warwick Butt Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease Received: 24 March 2010 Accepted: 2 February 2011 Ó Copyright jointly held by Springer and ESICM 2011 D. Best Á L. S. Shekerdemian Á W. Butt Department of Paediatric Intensive Care, The Royal Children’s Hospital, Melbourne, Australia C. P. Brizard Á Y. d’Udekem Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Australia V. Ben Sivarajan ( ) ) Divisions of Cardiac Critical Care and Cardiology, Department of Critical Care Medicine and Paediatrics, The Hospital for Sick Children, Rm 2836, 555 University Ave, Toronto, ON M5G 1X8, Canada e-mail: ben.sivarajan@sickkids.ca Tel.: ?1-416-8137654 Fax: ?1-416-8137299 Abstract Purpose: Survival out- comes in children with heart disease after use of either non-emergent extracorporeal membrane oxygena- tion (ECMO) or cardiopulmonary resuscitation (CPR) onto ECMO (ECPR) are comparable. Concerns remain regarding the impact of CPR duration on survival and neurological outcome. Methods: Children with cardiac disease requiring ECMO were identified from our database. Demo- graphic, operative and ECMO details were evaluated with respect to sur- vival. In addition, resuscitation details were extracted for the recent sub- group requiring ECPR; these details were evaluated with respect to sur- vival and neurological outcomes at midterm follow-up by univariate analysis and multivariable logistic regression. Results: There were 126 ECMO runs in 116 children; 61 (53%) received ECPR. Forty-eight (41%) children survived to discharge; survival in the most recent era was 48%. Thirty-seven children under- went ECPR in the most recent era with 14 (38%) surviving to discharge. Duration of cardiopulmonary resus- citation differed significantly between survivors and nonsurvivors (15 vs. 40 min, p = 0.009); children requir- ing C30 min of CPR had 79% reduced odds of hospital survival (OR = 0.21, 95% CI = 0.05–0.96, p = 0.04). Two children died after hospital discharge; with 33% having paediatric cerebral performance cate- gory scores B2. Poor neurological outcome was associated with longer duration of CPR (32 vs. 17.5 min, p = 0.03). Conclusions: Despite comparable survival outcomes between ECPR and non-emergent ECMO in children with cardiac dis- ease a significant association between CPR duration and outcome (survival and neurological) was noted in this population. Keywords Congenital heart disease Á Cardiac arrest Á Extracorporeal Á Outcomes Á Cardiopulmonary resuscitation Á Paediatrics Introduction Children after in-hospital cardiac arrest continue to have significant morbidity and mortality [1]. Survival to hos- pital discharge after in-hospital paediatric cardiac arrest is reported to be between 13 and 27% [1–8] with conven- tional resuscitation. A large study of cardiac arrest involving 880 children from 156 institutions demon- strated a 27% survival to discharge [1]. Requiring more than 15 min of cardiopulmonary resuscitation (CPR) has been associated with poor outcome [3, 8]. Numerous studies have documented successful use of extracorporeal membrane oxygenation (ECMO) during CPR (ECPR) [9, 10] in children with cardiac disease [11, 12]. Reported Intensive Care Med DOI 10.1007/s00134-011-2168-6 PEDIATRIC ORIGINAL